Aortic root geometry in patients with aortic stenosis assessed by real-time three-dimensional transesophageal echocardiography

Victor Chien-Chia Wu, Kyoko Kaku, Masaaki Takeuchi*, Kyoko Otani, Hidetoshi Yoshitani, Masahito Tamura, Haruhiko Abe, Fen Chiung Lin, Yutaka Otsuji

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

25 Scopus citations


Background The authors hypothesized that aortic root geometry is different between bicuspid and tricuspid aortic stenosis (AS) that can be assessed using real-time three-dimensional (3D) transesophageal echocardiography. The aims of this study were (1) to validate the accuracy of 3D transesophageal echocardiographic measurements of the aortic root against multidetector computed tomography as a reference, (2) to determine the difference of aortic root geometry between patients with tricuspid and bicuspid AS, and (3) to assess its impact on pressure recovery. Methods In protocol 1, 3D transesophageal echocardiography and contrast-enhanced multidetector computed tomography were performed in 40 patients. Multiplanar reconstruction was used to measure the aortic annulus, the sinus of Valsalva, and the sinotubular junction area, as well as the distance and volume from the aortic annulus to the sinotubular junction. In protocol 2, the same 3D transesophageal echocardiographic measurements were performed in patients with tricuspid AS (n = 57) and bicuspid AS (n = 26) and in patients without AS (n = 32). The energy loss coefficient was also measured in patients with AS. Results In protocol 1, excellent correlations of aortic root geometric parameters were noted between the two modalities. In protocol 2, compared with patients without AS, those with tricuspid AS had smaller both sinotubular junction areas and longitudinal distances, resulting in a 23% reduction of aortic root volume. In contrast, patients with bicuspid AS had larger transverse areas and longitudinal distances, resulting in a 30% increase in aortic root volume. The energy loss coefficient revealed more frequent reclassification from severe AS to moderate AS in patients with tricuspid AS (17%) compared with those with bicuspid AS (10%). Conclusions Three-dimensional transesophageal echocardiography successfully revealed different aortic root morphologies between tricuspid and bicuspid AS, which have different impacts on pressure recovery.

Original languageEnglish
Pages (from-to)32-41
Number of pages10
JournalJournal of the American Society of Echocardiography
Issue number1
StatePublished - 01 2014


  • Aortic root geometry
  • Bicuspid aortic stenosis
  • Three-dimensional echocardiography
  • Transcatheter aortic valve replacement
  • Tricuspid aortic stenosis


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